1. ACADEMIC STANDARDS Council Rock Health Services Department December 5, 2013

2.  Definition of School Nursing  “School nursing is a specialized practice of professional nursing that advances the well-being, academic success and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning.”(NASN, 2010) School Nursing

3. Academic Requirements for School Nurse Certification Pennsylvania: School nurses must obtain registered Nurse licensing to practice as a registered nurse. School Nurse Certification requirements are: Bachelor Of Science degree in Nursing Completion of a PDE approved school nurse certification program. Level I certificate issued Level I Pennsylvania Instructional and Educational Specialist certifications are valid for six (6) years of service, not calendar years. If you have been employed as a certified school nurse in Pennsylvania on a Level l certificate for 3-6 years of satisfactory service and have earned 24 post-baccalaureate credits, you can apply for a Level ll certificate.

4. Mandated School Health Program The School Health Program facilitates the healthy growth and development of children of school age in Pennsylvania. The School Health Program serves all children of school age attending public, private and non-public schools in Pennsylvania. This program prevents and detects health problems, and maintains and improves the health status of students. Council Rock School Nurses service 20 school public, private and alternative school settings in the district 3 High Schools: CR North, CR South and Villa Joseph Marie 3 Middle Schools: Holland Middle, Newtown Middle, Richboro Middle St. Andrew’s (STA) and St. Katherine Drexel (SKD) 10 Elementary Schools, CES, GES, HCE, HES, MMW, NES, RES, RHE, SFE, WED. 2 Private Kindergartens: Ohev Shalom and Shir Ami 2 Alternative school Settings: Theodore A. Sloan/ Achieve and Sail House

5. Certified School Nurses and Non-Certified Staff Nurses 14 Certified Nurses # of Students Assigned Nurses Name School Assignment (404 + 731) Sarah BarfootRHE + STA * Access (774/50 SPED ) Carol BaronGES + Sail House (1054/17 SPED)Carrie BlumenthalCRHS-South +MDS+ Sloan/Achieve (663/4 SPED)Nancy Cook-NES + MDS Class (999)Dana DanielsSFE + WES (864/25 SPED)Jeanene HechtNMS (960/17 SPED)Sheri JokicRMS + RES (959/15 SPED)Judy KaufmannMMW + HES (917/23 SPED)Teri LavinCRHS North + Sloan/Achieve (1053/18 SPED)Tina LathamCRHS South + MDS+ Sloan/Achieve (916/24 SPED)Julie MooreCRHS North + Sloan/Achieve (637+ 380)Janet OstoyichCES + VJM (521 + 392-32-18)Julie RoccograndiHCE + SKD + Shir Ami+OHEV (516) 25 SPEDLynn SmithHMS + Coordinator SPED) 11 Staff Nurses- Michele Adames, Suzanne Alden, Debbie Cattolico, Nancy Crivaro, Dianne Ernest, Mary Jordan, Dianne Mullin, Helen Rodriquez, Suzanne Tentilucci, Janine White, Pam Wolfe. PUBLIC ENROLLMENT Elementary- 5,407 Middle- 1,890 High School 3,340 TOTAL 11,278 PRIVATE ENROLLMENT STA 731, SKD 392, SHIR AMI 32, OHEV18, Total 1,173 GRAND TOTAL 12,451

6. Mandated School Health Program Segment 1Segment 1 - Introduction Segment 2 Segment 2 - Nurse Practice Act and Regulations Segment 3Segment 3 - School Health Law and Regulations Segment 4- Department of Education (This link is currently nonfunctional) Segment 5Segment 5 - Documentation Segment 6Segment 6 - Medication Administration Segment 7Segment 7 - Immunization Requirements Segment 8Segment 8 - Child Protection Law Segment 9 Segment 9 - Special Education/Special Health Care Issues (Information on Specific Chronic Diseases are now located here.)here. Segment 10Segment 10 - School Health Program – Screens/Physical Examinations/TB Testing Segment 11 Segment 11 - Dental Health Program Segment 12 Segment 12 - Annual Request for Reimbursement and Report of School Health Services Segment 13 - Communicable Diseases/Bloodborne Pathogens Segment 14 - All-Hazard Planning Segment 15 - Environmental Segment 16 - Resources (This link is currently nonfunctional).

7. Council Rock Health Services Web Site Welcome to Council Rock Health Services

8. State Mandated Program IMMUNIZATIONS Council Rock School Board Policy 201 Communicable Diseases and Immunizations Pennsylvania State Law and Regulations Pennsylvania Code Subchapter C. IMMUNIZATION 23.83. Immunization requirements. (a) Duties of a school director, superintendent, principal or other person in charge of a public, private, parochial or nonpublic school. Each school director, superintendent, principal, or other person in charge of a public, private, parochial or nonpublic school in this Commonwealth, including vocational schools, intermediate units, and special education and home education programs, cyber and charter schools, shall ascertain that a child has been immunized in accordance with the requirements in subsections (b), (c) and (e) prior to admission to school for the first time, under section 1303 of the Public School Code of 1949 (24 P. S. § 13-1303a) regarding immunization required; penalty. (b) Required for attendance. The following immunizations are required as a condition of attendance at school in this Commonwealth:

9. State Mandated Program Continued School Immunization Requirements For ALL Students Children in ALL grades (K-12) need the following vaccines: 4 doses of tetanus*(1 dose on or after 4 th birthday) 4 doses of diphtheria* (1 dose on or after 4 th birthday) 3 doses of polio 2 doses of measles** 2 doses of mumps** 1 dose of rubella (German measles) ** 3 doses of hepatitis B 2 doses of varicella (chickenpox) or evidence of immunity *Usually given as DTP or DT or Td **Usually given as MMR State Immunization RequirementsState Immunization Requirements – PA. CODE Subchapter C-Immunization

10. State Mandated Program Continued State Immunization RequirementsState Immunization Requirements – PA. CODE Subchapter C- Immunization 7 th Grade ADDITIONAL immunization requirements for entry: 1 dose meningococcal conjugate vaccine (MCV) 1 dose of tetanus, diphtheria, acellular pertussis(Tdap) [if five years have elapsed since last tetanus immunization]

11. State Mandated Program Continued The only exemptions to the school laws for immunizations are: medical reasons; religious beliefs; or NEW: philosophical/strong moral or ethical convictionNEW: philosophical/strong moral or ethical conviction. If your child is exempt from immunizations, he or she may be removed from school during an outbreak.

12. State Mandated Program Continued REGISTRATION CRSD Health Forms Required for ALL RegistrationCRSD Health Forms Required for ALL Registrations At the time of registration, you must submit written proof of your child's immunizations signed by a physician. PA law requires that proof of immunization must be provided before a child can be admitted to any public, private or parochial school. Please read the Health Letter to Parents Grades K-1Grades K-1 / (Grades 2-12). The following forms can be downloaded from the website, obtained from Central Registration or the school:(Grades 2-12) Physician Immunization Form (#37)Physician Immunization Form (#37)- Private Physician Form (#511)Private Physician Form (#511)- Private Dental Exam (Grades K-8) Health History (Grades K-6) Health History (Grades 7-12)

13. State Mandated Program Continued Registration process Immunization review and Family Health History Review New registrations for 2013 - 593 Physical Exams(Grades k-11): private(PP) and school (SP) PP 2012-2013 3,753SP- 2012-2013 -8Referred 2012-2013 6 Dental Exams (Grades K-8) private(PD) and school (SD) PD 2012-2013- 2,628 SD 2012-2013- 89 Referred 32 Scoliosis screening (Grades 6-7) 2012-2013-1,969Referred-35

14. Communicable Diseases Requiring Exclusion State Mandated Program Continued Communicable Diseases Requiring Exclusion 28 PA Code, Chapter 27 Communicable and Non-communicable Disease "Disease Prevention and Control Law of 1955". Council Rock School Board Policy 203 Council Rock School Board Policy 203 It is important that the health office be notified if your child contracts a communicable disease. If a communicable disease is suspected in school, the parent will be notified and the child will be excluded from school. The student will not be readmitted before the minimum number of days designated by the State and Local Departments of Health which are: Diphtheria – 2 weeks from the onset or until appropriate negative culture tests. Chicken Pox** – 5 days from onset of the last crop of vesicles (blisters). All vesicles must be dried and crusted before returning to school. Rubella (German Measles) – 4 days from onset of rash. Rubeola (Regular Measles) – 4 days from onset of rash. Mumps – 9 days from onset or until subsidence of swelling. Pertussis (whopping cough) – 3 weeks from the onset or five days from institution of appropriate therapy. Respiratory streptococcal infections (including Scarlet Fever) – Not less than 10 days from the onset if no medication is prescribed or 24 hours from the institution of appropriate therapy.

15. Communicable Diseases Requiring Exclusion State Mandated Program Continued Communicable Diseases Requiring Exclusion Acute Contagious Conjunctivitis (Pink Eye) – Until judges non-infective; that is, without a discharge (usually after 24 hours after institution of appropriate therapy). Ringworm – Immediately after therapy is instituted, if body lesions are covered. Neither scalp nor body lesions that are dried need to be covered. Impetigo Contagiosa – 24 hours from institution of appropriate therapy. Pediculosis Capitis (Head Lice) – After the first treatment and until judged non-infective by the school nurse or child’s physician. Council Rock has a no-nit policy – therefore all nits must be removed from a student’s hair before returning to school after treatment for pediculosis. Pediculosis Corpora (Body Lice) – After completion of appropriate treatment and judged non- infective by the school nurse or child’s physician. Scabies – After completion of appropriate therapy and until judged non-infective by the school nurse or child’s physician. Trachoma – 24 hours from institution of appropriate therapy. Tuberculosis– Following a minimum of 2 weeks of adequate chemotherapy and 3 consecutive sputum smears. In addition, a note from the physician that the child is non-communicable shall be submitted prior to readmission. Neisseria menigitidis – Until judged non-infective after a course of rifampin or other drug which is effective against this disease, or otherwise shown to non-infective.

16. State Mandated Program Continued Mandated Screenings Students in the District are scheduled to receive mandated screening examinations in accordance with the following schedule: Vision, growth and development Annually……… Kindergarten through 12th grade Hearing Annually…………………………….. Kindergarten through 3rd grade, 7 th grade and 11th grade. Annually for all special education student’s with hearing concerns Medical examination…………………….. Kindergarten or First, 6th and 10th grade Dental examination………………………..Kindergarten or First, 3rd and 7th grade Scoliosis screening……………………….. 6th and 7th grades The District recommends that all medical and dental examinations be administered by the family physician and dentist since they can best evaluate the child’s health and assist in obtaining necessary treatment and corrections. In the case of financial need, any child not seen by a private physician or dentist for the mandated medical and dental examinations will be scheduled to be seen by the school physician and dentist. All students who are entering Council Rock School District as transfers from other school districts are required to have current medical and dental examinations.

18. State Mandated Program Continued Total screenings completed 2012-2013 VISION:12,884 961 referrals HEARING: 6,293 175 referrals HEIGHT & WEIGHT:K-6 6,304 7-12 7,424 BLOOD PRESSURE:5,890 SCOLIOSIS:1,969 35Referrals

19. State Mandated Program Continued Health Office Visits All student and staff health office visits are entered into the daily log. For all serious injuries a CRSD accident report is completed as well. Injury/First Aid:54,170 Illness:117,429 Students sent home with health reasons:8499 Students requiring skilled nursing care:904 Students with a IHP/504/IEP with medical:941 Students emergency requiring 911:17 Health Services for staff and other adultsIllness- 2,022 Injury 648 EMS 8

20. State Mandated Program Continued Absentee Tracking Council Rock School Board Policy # 204 Pennsylvania Truancy Elimination Plan In accordance with school Board policy and Pennsylvania Compulsory Attendance and Truancy Elimination Plan (24 P.S. 13-1327), School Nurses assist tracking student absence by contacting parents/guardians on the third day of absence to inquire about the health of the student. School Nurses receive medically excused absence notes and collaborate with the attendance office and the educational staff if accommodations are needed when a student returns to school after an injury or extended illness. School Nurses in middle school and high school are also part of the attendance team and meet on a regular basis to support students, families and encourage regular attendance.

21. Medication Administration Number of Doses Administered BY Individual MD OrderBy Standing Order Analgesic 36814,179 Antibiotic 3017,045 Anticonvulsant1,098 Antihistamine/Decongestant 1855 Anti-inflamatory 607532 Asthmatic 3,670 Diabetic 9,080 Gastrointestinal 8689,507 Psychotropic ADD/ADHD 4,994 all other 1,437 Other 1,2354,806 TOTAL 23,84336,074

22. Medication Management in Diabetes Insulin Syringe

23. Medication Management in Diabetes Insulin Pen

24. Medication Management in Diabetes Administering Insulin via an Insulin Pump

25. Medical Emergency in Diabetes Glucagon

26. AUVI-Q

27. State Mandated Program: Medication Administration Auvi-Q -epinephrine auto ‑ injector that is easy to use. I talk you through the injection process step by step. Watch and see how easy I am to use. Auvi-Q demo Seek immediate medical treatment after use. Each Auvi-Q contains a single dose of epinephrine. Auvi ‑ Q should only be injected into your outer thigh. Anaphylactic Reaction- Anaphylaxis is a life-threatening allergic reaction that can occur quickly (as fast as within a couple of minutes). Symptoms of anaphylaxis vary, but can include hives, itching, flushing, and swelling of the lips, tongue, and roof of the mouth. The airway is often affected, resulting in tightness of the throat, chest tightness and difficulty breathing. Students with severe allergies may experience an anaphylactic reaction and need an epinephrine injection quickly. These students may have a emergency action plan.

28. EpiPen

29. State Mandated Program Medication Administration Continued How to Use EpiPen Auto-Injector Step-by-Step instructions Prepare the EpiPen or EpiPen Jr Auto-Injector for Injection Remove the auto-injector from the clear carrier tube. Flip open the yellow cap of your EpiPen or the green cap of your EpiPen Jr Auto-Injector carrier tube. Tip and slide the auto-injector out of the carrier tube. Grasp the auto-injector in your fist with the orange tip pointing downward. With your other hand, remove the blue safety release by pulling straight up without bending or twisting it. Note: The needle comes out of the orange tip. Never put your thumb, fingers or hand over the orange tip. Administer the EpiPen or EpiPen Jr Auto-Injector Hold the auto-injector with orange tip near the outer thigh. Swing and firmly push the orange tip against the outer thigh until it “clicks”. Keep the auto-injector firmly pushed against the thigh at a 90° angle (perpendicular) to the thigh. Hold firmly against the thigh for approximately 10 seconds to deliver the drug. The injection is now complete. Finalize the Injection Process Remove the auto-injector from the thigh. The orange tip will extend to cover the needle. Massage the injection area for 10 seconds. Get emergency medical help right away. You may need further medical attention. You may need a second EpiPen or EpiPen Jr Auto-Injector should symptoms persist or recur. Note: Take your used auto-injector with you when you go to see the health care provider. Video: http://www.epipen.com/How-to-Use-EpiPenhttp://www.epipen.com/How-to-Use-EpiPen

30. Individualized Health Care Plan/Section 504 plan Individual Health Care Plan Emergency Action Plan These plans are most frequently written for : Asthma leukemia Bee Sting allergyleukemia remission Concussionlymphoma Crohns/IBSpeanut allergy temporary use of crutches/wheelchairlatex allergy Diabetesseizures food allergysickel cell anemia fractureother health concern Immunosuppression Number of students with Chronic conditions 2012-2013 are: Arthritis/Rhumatic Disease 32Diabetes Type 1 38 Asthma 1,530Diabetes Type II 1 Attention Deficit Disorder 598Epilepsy & other seizure disorders 104 Cardiovascular conditions 325Sickle Cell Disease 1 Cerebral Palsy 23Spina Bifida 1 Cystic Fibrosis 2Tourette’s Syndrome 38

31. Sample Individualized Health Care Plan/Section 504 plan

32. Sample Individual Health Care Plan

33. Sample Emergency Action Plan

34. Serious Injuries Nature of Injury ; Burns 3 Concussion 98 Contusions 32 Cut/Lacerations 53 Dental injuries 22 Dislocations (possible) 6 Eye Injuries 20 Fracture (possible) 84 Sprain/Strain/Tear 63 Other 19 Total Serious Injuries for 2012-2013 400

35. CRSD Accident Report

36. Council Rock School District Sudden Cardiac Arrest Awareness CPR/AED Training CRSD School Board Policy 822 CRSD School Board Policy 123.2 CRSD School Board Policy 822 CRSD School Board Policy 123.2 Council Rock has two school board policies that support the placement of AED’s in our schools and supporting continuous CPR/AED training. CRSD School Board Policy # 822 “AUTOMATED EXTERNAL DEFIBRILLATOR (AED) CARDIOPULMONARY RESUSITATION (CPR) “ to maintain AED units and staff trained in CPR/AED resuscitation CRSD School Board Policy # 123.2 “Sudden Cardiac Arrest” to provide guidance for prevention and recognition of sudden cardiac arrest in student athletics.

37. CPR/AED Staff Training Program AED’s are placed in all CRSD Public schools. Staff training workshops for Emergency CPR/AED use is ongoing. Maintenance of the AED’s in our schools is overseen by school nurses.

38. CPR/AED Staff Training Program American Heart Association Cardiac Chain of Survival Early Recognition-to prevent cardiac arrest Early CPR-to buy time Early Defibrillation-to restart the heart Post Resuscitation Care to restore quality of life. The Council Rock School District encourage teachers and staff to become trained in Cardiopulmonary Resuscitation (CPR) and the use of an automated external defibrillators (AED’s). Each month in district training workshops are offered by CRSD CPR/AED instructors in a different location throughout the district. To date over 1,000 teachers and staff have bee trained.

39. First Aid for Choking

41. Health Services Medical Management of Concussions What should I know about Concussions? Know The Facts and Know the Symptoms CRSD School Board Policy 123.1

46. Medical Access Program Council Rock School Nurses provide staff training for First aid / Heart saver/ CPR/AED for support staff as required by Access For students receiving access CRSD Nurses complete a nursing log each month

48. Thank you for the privilege of presenting the Academic Standards for Health Services Every Child Deserves a School Nurse! Thank You